Senior Analyst, Provider Compliance

4004 Aetna Medicaid Administrators; United States; On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources, based on eligibility

Job summary

CVS Health seeks a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across the organization. You will lead strategic initiatives to ensure accurate audit results and strengthen regulatory relationships, while implementing proactive risk mitigation.

The role requires deep expertise in compliance and analytics, with the ability to influence outcomes and standardize processes across teams.

Qualifications

• Progressive audit/compliance/healthcare operations experience (minimum 3 years).
• Ability to develop and execute detailed project plans with accountability.
• Strong analytical skills to interpret data and drive solutions.
• Excel proficiency for data analysis and reporting to strengthen controls.

Responsibilities

• Lead quality internal/external Medicaid provider audits and regulatory deliverables.
• Interpret findings and recommend corrective actions to mitigate risk.
• Support complex inquiries from stakeholders and regulators with accuracy.
• Lead multiple compliance projects and ensure timely execution and outcomes.
• Oversee policy and annual review documentation updates.
• Build partnerships across levels to influence compliant, ethical outcomes.

Skills

Audit leadership

Compliance expertise

Analytical skills

Advanced Excel

Communication

Project leadership

Education

Bachelor’s degree

Tools

Provider data management platforms

Microsoft Excel (advanced)

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

About the Role

We are seeking a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across our organization. In this role, you will lead strategic initiatives that ensure accurate, timely, and high-quality audit results, strengthen regulatory relationships, and implement proactive measures to mitigate risk. You'll partner cross-functionally to optimize audit results and implement preventative measures to mitigate risk, while influencing best practices that enhance operational efficiency and compliance. If you are a proactive problem solver with strong leadership skills and a passion for delivering sustainable, compliant solutions, we want to hear from you.

Position Summary

Leads and ensures the delivery of high-quality internal and external Medicaid provider audit results, regulatory compliance activities, and proactive risk mitigation strategies. Applies deep expertise in compliance, business operations, analytics, and communication to develop and execute strategies that support regulatory and contractual obligations. Partners cross-functionally to support accurate, complete, and timely audit and regulatory deliverables, standardize processes, optimize workflows, and enable data integrity across the organization. Drives and supports provider compliance initiatives that promote consistency, accuracy, compliance, and operational excellence. The ideal candidate is a strategic, solutions-oriented leader with strong analytical and communication skills, capable of influencing outcomes and implementing best practices that enhance audit performance, regulatory relationships, and operational efficiency. This role requires technical acumen, critical thinking, and the ability to lead complex initiatives in a dynamic environment.

Key Responsibilities

• Direct and foster best-in-class collaboration with internal teams and external auditors to deliver quality results, ensure continuous improvement, and maintain compliance.
• Interpret audit findings to recommend sustainable corrective actions and process improvements that mitigate risk.
• Support the response to complex inquiries from internal stakeholders and regulators with accuracy, timeliness, and completeness.
• Serve as a technical and functional leader, managing multiple compliance-related projects and deliverables to ensure timely execution and desired outcomes.
• Oversee policy and procedural documentation development and the timeliness of required annual reviews.
• Build and sustain productive partnerships across all organizational levels; exercise sound judgment, remove barriers, and influence ethical, compliant outcomes to achieve strategic goals.

Required Qualifications

• Minimum of 3 years of progressive experience in audit, compliance, or related healthcare operations.
• Proven ability to develop and execute detailed project plans with accountability and rigor to deliver complex initiatives successfully.
• Strong analytical skills with demonstrated ability to interpret data, identify trends, and recommend actionable solutions for compliance-related challenges.
• Experience with Microsoft Excel with advanced proficiency for data analysis and reporting to strengthen internal controls and mitigate risk.
• Exceptional ability to convey complex information clearly and concisely, build relationships across organizational levels, and influence decision-making.
• Ability to lead initiatives, mentor team members, and thrive in a fast-paced, evolving environment while maintaining compliance and quality standards.

Preferred Qualifications

• 5 years of progressive experience in audit, compliance, or related healthcare operations.
• Ability to interpret and apply business knowledge to implement state and federal laws and regulations impacting healthcare operations.
• Three or more years of demonstrated success leading audits, complex projects, ensuring timely delivery, and driving measurable outcomes.
• Three or more years of experience managing provider data operations, including compliance.
• Three or more years of experience in network management, contracting, or related healthcare network functions.
• One or more years of hands-on experience with provider data management platforms.

Education

Bachelor's degree preferred/specialized training/relevant professional qualification.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $46,988.00 - $112,200.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Great benefits for great people

• medical coverage
• dental coverage
• vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We anticipate the application window for this opening will close on: 11/09/2026

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.